EPC-Timbuktu Academy--1995/96--Page -1- of 6. Deadline: 2/25/96
for High School Students; Rolling Admission thereafter.

ENGINEERING, PHYSICS, CHEMISTRY (EPC)
AT THE TIMBUKTU ACADEMY

Supported by the Department of the Navy, Office of Naval Research

Please select one or two (at most) below. SBI & URP may be both checked by High School Seniors.The deadline for the receipt of all the materials is February 25, each year, for High School Students.


Summer Science Institute(SSI) :
Summer Bridge Institute (SBI) :
Undergraduate Research Program (URP):

PLEASE TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES.

    
    

    Applicant Information:

  1. Name :
  2. Address : City : State : Zip Code:
  3. Phone Number:
  4. Date of Birth:
  5. Sex
  6. Citizenship : (US citizenship Required)
  7. Social Security Number:
  8. Ethnic Background :(FOR STATISTICAL PURPOSES ONLY; THIS IS NOT A FACTOR IN THE SELECTION)
    (Please specify)

  9. Parents or Guardians information:


    Name : Street : City : State : Zip Code: phone :
  10. Current Academic Status

    (19##-19##)(School Year )
  11. High School information :

    Name : Address:
  12. HS GPA(#.##/4.0) College GPA (if applicable)(#.##/4.0) Current or Future College Major:
  13. ACT or SAT scores:

    ACT: Composite: Math:
    SAT: Verbal: Math:
    Please attach one copy of each of the relevant test scores (ACT or SAT) with your application.
  14. Expected Graduation Date

    Expected HS Graduation Date(MM/YY) Expected College Graduation Date(MM/YY) (if currently in college)
  15. Activities, Awards and Honors:

    List school activities in which you have participated (e. g.,student government, sports, music, science or other special interest clubs or organizations). List community activities in which you have participated (e. g., church or volunteer work). List any awards, honors or offices held with year.
  16. Recommendation Information

    Please list below the name, title, affiliation, and office phone number of the three (3) individuals you have asked to provide a recommendation. Ask each of them to fill out the accompanying recommendation form and to return it by the applicable deadline.

    Name: Title: Telephone: Name: Title: Telephone:

  17. Transcript:

    Please include a current official transcript.
  18. Essay:

    On a separate sheet, please describe your career goals, interest in science, and previous science experiences (science fairs/rallies, summer research, summer enrichment, etc.) if any. Signature of Applicant Date
Please Read Information Under This Form
Your completed application. transcript. verification of test results. essay, and three letters of recommendation should be sent to:

Dr. Diola Bagayoko
Director, The Timbuktu Academy
Department of Physics P. 0. Box 11776
Southern University and A&M College
Baton Rouge, LA 70813
Telephone; (504) 771-2730/-4130; Fax: (504) 771-4341/-4722
Internet: bagayok@phys.subr.edu ; Bitnet:bagayok@aol.com

The deadline for the receipt of all the materials is February 25, of each year

The Postulate of Timbuktu:

There is no known limit to what a given person can learn or discover, even though what a person learns or discovers is partly determined by that person's determination, focus, courage, and perseverance.

IMPORTANT NOTE:

Students applying for the Summer Bridge Institute (SBI) or for the Undergraduate Research Proaram (URP) must also apply for admission at Southern University and A&M College (SUBR)- for the Summer and the Fall), They are also urged to apply for the Louisiana Tuition Opportunites Program (TOPS).


Failure to apply timely for admission at SUBR will result in the rescinding of any SBI or URP award, as the latter can only be consummated for students officially enrolled at SUBR.


Most High School Guidance Counselors have the complete Application Form for Admission at Southern University and A&M College (SUBR). The SUBR Office of Admissions has the following contact


INFORMATION:

Office of Admissions, Room 113 T. H. Harris Hall,Southern University and A&M College, Baton Rouge,LA 70813 or office of Admissions, P.0. Box 9901, Baton Rouge, LA 70813. Telephone: (504) 771-2430.